A healthier course

A psychology doctoral student examines ways to help war veterans heal through therapeutic adventure.

September 2013, Vol 44, No. 8

Print version: page 54

David E. Scheinfeld juggles two challenging but meaningful roles: one as a counseling psychology graduate student at the University of Texas at Austin, and the other as an Outward Bound instructor, a job he's held since 2003.

Scheinfeld has long been interested in combining his interests in therapy with male clients and outdoor adventure. In 2009, his interest became even more specific when he led his first Outward Bound course with Iraq and Afghanistan veterans and saw firsthand many veterans' longing for deeper connections and support systems within their own ranks. The Outward Bound ideas jelled during a practicum he did at the Austin Veterans Administration in 2011. (Outward Bound — an organization launched in 1962 that leads outdoor adventure expeditions designed to build character, teach leadership skills and inspire personal growth — has been providing such courses for veterans since 1983. It now funds travel and courses for more than 600 veterans a year through a program called Outward Bound for Veterans.)

"I saw a real need to provide alternative avenues [to traditional therapy] for veterans to get together and regain a sense of belonging," says Scheinfeld, who has led six courses with this population in all. "These programs give them a different space to think through how they can best take care of themselves as they reintegrate into civilian life."

While the trips he's led have been structured like traditional Outward Bound courses, Scheinfeld believes they have great therapeutic value for these veterans, especially those who may not seek out traditional therapy.

"The military tends toward a hegemonic masculine culture, where it's often not OK to share your thoughts and feelings, and you're encouraged to be strong and push through things," he says. "Ultimately the [Outward Bound] program isn't set up to be overt therapy, and I actually think that's a good thing."

Building an evidence base

That said, Scheinfeld determined it would be helpful to veterans already familiar with therapy work to add a more structured therapeutic element to these trips, while retaining the complete flavor of a wilderness adventure. So he helped to develop a therapeutic curriculum to be used in conjunction with an Outward Bound trip for veterans, envisioning it as a complementary, alternative approach to regular therapy.

In January 2011, that curriculum was put into practice on a sea-bound venture from Key Largo, Fla., a trip that included five Iraq and Afghanistan veteran volunteers who were members of an existing post-traumatic stress disorder therapy group, two other Outward Bound instructors, Scheinfeld, and a second research observer.

The group spent six days in a 30-foot pull boat, navigating through the Florida Bay, cooking their own food and learning how to work as a team to sail or row the boat — a first for many of the veterans.

Because of the curriculum, the journey had a more explicit therapeutic focus than a typical Outward Bound trip. But many ingredients were the same: Teamwork was essential to the trip's success, with veterans helping each other read charts, set the oars and navigate changing weather conditions, all with a good deal of joking and camaraderie.

"I hear these veterans talk about the stress or isolation back home, so it's wonderful to see them open up and have fun together again, just like when they were in the service," Scheinfeld says. "For many, this re-experiencing of the good times, the laughter and bonding, can be immensely therapeutic."

The veterans also set personal goals, or "action plans" for taking better care of themselves, their families and other relationships. One veteran, for instance, sought to quell his panic attacks, which he had experienced frequently since returning home from war.

He got the opportunity: While he was snorkeling, he had a minor panic attack. The entire team, supported by Scheinfeld, helped him through it by coaching him to focus on a single object and slow down his breathing. Once the man's anxiety abated, he and some of the veterans voted to take a swim together as a team.

"That was an important experiential moment and life metaphor for him," recalls Scheinfeld. "The veteran appreciated the opportunity to not be ‘rescued' — to develop his own skills for managing anxiety — but also to reach out for communal support."

That experience carried over at home, as well, Scheinfeld adds. "He used that moment as a reference point, telling himself that if he could manage that, he could manage other panic attacks in the future. From that moment on, he had a renewed commitment to manage his anxiety through therapy and personal development."

Carrying it forward

Scheinfeld is now considering ways to continue this work through grants and other means, for example, by creating partnerships between Outward Bound and other community agencies.

In fact, his dissertation is examining the efficacy of integrating veteran-centered therapeutic interventions with outdoor adventure, such as Outward Bound. He is using the results — which show that these courses increase participants' overall mental health, sense of belonging, ability to relate to and express emotions, self-confidence and health, among other positives outcomes — to consult with Chad Spangler, director of the Outward Bound for Veterans program. This information will help the organization develop more informed training and curriculum design, Scheinfeld says.

The objective is to use Outward Bound as a door opener — a way to help veterans begin to address important emotional issues and promote social connection, but not to go so deep that they open wounds they can't heal.

His dual roles should help him strike that medium, Scheinfeld adds.

"My roles as a psychologist-in-training and an Outward Bound instructor allow me to think about effective curricula that will allow for that balance," he says.